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Clinical effectiveness of treatment strategies for prosthetic joint infection following total ankle replacement: A systematic review and meta-analysis

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@article{3134a7488931416690303610f9b0ed3b,
title = "Clinical effectiveness of treatment strategies for prosthetic joint infection following total ankle replacement: A systematic review and meta-analysis",
abstract = "Prosthetic joint infection (PJI) after total ankle replacement (TAR) is a challenging complication, which often requires debridement and implant retention (DAIR) with or without polyethylene exchange; revision surgery; implantation of a cement spacer; conversion to arthrodesis; or even amputation. The optimum treatment for ankle PJI is not well established. We conducted a systematic review and meta-analysis to compare the clinical effectiveness of various treatment strategies for infected ankle prostheses. We searched MEDLINE, Embase, Web of Science, and The Cochrane Library up to December 2018 for studies evaluating the impact of treatment in patient populations with infected ankle prostheses following TAR. Binary data were pooled after arcsine transformation. Six citations comprising of 17 observational design comparisons were included. The re-infection rates (95{\%} CIs) for DAIR with or without polyethylene exchange, one-stage revision, two-stage revision, cement spacer, and arthrodesis were 39.8{\%} (24.4-56.1), 0.0{\%} (0.0-78.7), 0.0{\%} (0.0-8.5), 0.2{\%} (0.0-17.9) and 13.6{\%} (0.0-45.8) respectively. Rates of amputation for DAIR with or without polyethylene exchange and cement spacer were 5.6{\%} (0.0-16.9) and 22.2{\%} (6.3-54.7) respectively. Measures of function, pain, and satisfaction could not be compared because of limited data. One- and two-stage revision strategies seem to be associated with the lowest re-infection rates, but these findings are based on limited data. Arthrodesis and DAIR with or without polyethylene exchange appear to be commonly used in treating infected ankle prosthesis, but are associated with poor infection control. Clear gaps exist in the literature and further research is warranted to evaluate treatment strategies for infected ankle prosthesis.",
keywords = "prosthetic joint infection, ankle replacement, one-stage revision, two-stage revision, arthrodesis, meta-analysis",
author = "Kunutsor, {Setor K} and Matthew Barrett and Whitehouse, {Michael R} and Blom, {Ashley W}",
year = "2019",
month = "8",
day = "19",
language = "English",
journal = "Journal of Foot and Ankle Surgery",
issn = "1067-2516",
publisher = "Academic Press",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Clinical effectiveness of treatment strategies for prosthetic joint infection following total ankle replacement

T2 - A systematic review and meta-analysis

AU - Kunutsor, Setor K

AU - Barrett, Matthew

AU - Whitehouse, Michael R

AU - Blom, Ashley W

PY - 2019/8/19

Y1 - 2019/8/19

N2 - Prosthetic joint infection (PJI) after total ankle replacement (TAR) is a challenging complication, which often requires debridement and implant retention (DAIR) with or without polyethylene exchange; revision surgery; implantation of a cement spacer; conversion to arthrodesis; or even amputation. The optimum treatment for ankle PJI is not well established. We conducted a systematic review and meta-analysis to compare the clinical effectiveness of various treatment strategies for infected ankle prostheses. We searched MEDLINE, Embase, Web of Science, and The Cochrane Library up to December 2018 for studies evaluating the impact of treatment in patient populations with infected ankle prostheses following TAR. Binary data were pooled after arcsine transformation. Six citations comprising of 17 observational design comparisons were included. The re-infection rates (95% CIs) for DAIR with or without polyethylene exchange, one-stage revision, two-stage revision, cement spacer, and arthrodesis were 39.8% (24.4-56.1), 0.0% (0.0-78.7), 0.0% (0.0-8.5), 0.2% (0.0-17.9) and 13.6% (0.0-45.8) respectively. Rates of amputation for DAIR with or without polyethylene exchange and cement spacer were 5.6% (0.0-16.9) and 22.2% (6.3-54.7) respectively. Measures of function, pain, and satisfaction could not be compared because of limited data. One- and two-stage revision strategies seem to be associated with the lowest re-infection rates, but these findings are based on limited data. Arthrodesis and DAIR with or without polyethylene exchange appear to be commonly used in treating infected ankle prosthesis, but are associated with poor infection control. Clear gaps exist in the literature and further research is warranted to evaluate treatment strategies for infected ankle prosthesis.

AB - Prosthetic joint infection (PJI) after total ankle replacement (TAR) is a challenging complication, which often requires debridement and implant retention (DAIR) with or without polyethylene exchange; revision surgery; implantation of a cement spacer; conversion to arthrodesis; or even amputation. The optimum treatment for ankle PJI is not well established. We conducted a systematic review and meta-analysis to compare the clinical effectiveness of various treatment strategies for infected ankle prostheses. We searched MEDLINE, Embase, Web of Science, and The Cochrane Library up to December 2018 for studies evaluating the impact of treatment in patient populations with infected ankle prostheses following TAR. Binary data were pooled after arcsine transformation. Six citations comprising of 17 observational design comparisons were included. The re-infection rates (95% CIs) for DAIR with or without polyethylene exchange, one-stage revision, two-stage revision, cement spacer, and arthrodesis were 39.8% (24.4-56.1), 0.0% (0.0-78.7), 0.0% (0.0-8.5), 0.2% (0.0-17.9) and 13.6% (0.0-45.8) respectively. Rates of amputation for DAIR with or without polyethylene exchange and cement spacer were 5.6% (0.0-16.9) and 22.2% (6.3-54.7) respectively. Measures of function, pain, and satisfaction could not be compared because of limited data. One- and two-stage revision strategies seem to be associated with the lowest re-infection rates, but these findings are based on limited data. Arthrodesis and DAIR with or without polyethylene exchange appear to be commonly used in treating infected ankle prosthesis, but are associated with poor infection control. Clear gaps exist in the literature and further research is warranted to evaluate treatment strategies for infected ankle prosthesis.

KW - prosthetic joint infection

KW - ankle replacement

KW - one-stage revision

KW - two-stage revision

KW - arthrodesis

KW - meta-analysis

M3 - Article

JO - Journal of Foot and Ankle Surgery

JF - Journal of Foot and Ankle Surgery

SN - 1067-2516

ER -